Assessment of the effect of left atrial cryoablation enhanced by ganglionated plexi ablation in the treatment of atrial fibrillation in patients undergoing open heart surgery
Assessment of the effect of left atrial cryoablation enhanced by ganglionated plexi ablation in the treatment of atrial fibrillation in patients undergoing open heart surgery
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DOI：
10.1186/s13019-017-0625-1
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发表时间：
2017-08-17
影响因子：
1.6
通讯作者：
Brat, Radim
中科院分区：
文献类型：
--
作者：
Barta, Jiri;Brat, Radim
背景资料：本研究的目的是探讨通过消融左心房的自主神经系统来增强左心房冷冻消融是否会影响接受心脏直视手术的结构性心脏病患者的房颤手术治疗结果。方法：观察的患者档案包括100名患者，他们在2012年7月至2014年12月期间在我科接受了联合心脏直视手术。患者因结构性心脏病而接受外科手术，并患有阵发性、持续性或长期持续性房颤。所有病例均在肺静脉电隔离、箱形病变、二尖瓣环连接病变、左心耳离断、左心耳基部与左肺静脉连接病变范围内行左心房冷冻消融术。其中35例患者接受了神经节丛标测和射频消融，以及马歇尔韧带的扩张和消融（GP组）。对照组65例，不进行神经节丛干预（LA组）。主要的主要结果是建立和持续时间的窦性心律的过程中，一年follow.Results：评估的人数与一个正常的窦性心律的百分比显示了可比的价值，在两组（GP组-93.75%，LA组-86.67%，p = 0.485）;在第12个月未接受抗心律失常治疗的正常窦性心律患者中也观察到类似的结果（GP组-50%，LA组-47%，p = 0.306）。我们没有观察到房颤复发与二尖瓣手术之间的任何关系，或者二尖瓣和三尖瓣手术与左心房直径> 50 mm之间的任何关系。在我们的人群中，在12- 20年的过程中，通过结状神经丛消融增强左心房冷冻消融术并不影响房颤手术消融的结果。月随访。
Background: The aim of our study was to investigate, whether enhancement of left atrial cryoablation by ablation of the autonomic nervous system of left atrium leads to influencing the outcomes of surgical treatment of atrial fibrillation in patients with structural heart disease undergoing open-heart surgery.Methods: The observed patient file consisted of 100 patients, who have undergone a combined open-heart surgery at our department between July 2012 and December 2014. The patients were indicated for the surgical procedure due to structural heart disease, and suffered from paroxysmal, persistent, or long-standing persistent atrial fibrillation. In all cases, left atrial cryoablation was performed in the extent of isolation of pulmonary veins, box lesion, connecting lesion with mitral annulus, amputation of the left atrial appendage and connecting lesion of the appendage base with left pulmonary veins. Furthermore, 35 of the patients underwent mapping and radiofrequency ablation of ganglionated plexi, together with discision and ablation of the ligament of Marshall (Group GP). A control group was consisted of 65 patients without ganglionated plexi intervention (Group LA). The main primary outcome was establishment and duration of sinus rhythm in the course of one-year follow-up.Results: Evaluation of the number of patients with a normal sinus rhythm in per cent has shown comparable values in both groups (Group GP -93.75%, Group LA -86.67%, p = 0.485); comparable results were also observed in patients with normal sinus rhythm without anti-arrhythmic treatment in the 12th month (Group GP -50%, Group LA -47%, p = 0.306). We have not observed any relation between the recurrence of atrial fibrillation and the presence of a mitral valve surgery, or between the presence of a mitral and tricuspid valves surgery and between the left atrial diameter > 50 mm.Conclusions: Enhancement of left atrial cryoablation by gangionated plexi ablation did not influence the outcomes of surgical ablation due to atrial fibrillation in our population in the course of 12-month follow-up.